Using the Lateral Vaginal Swabs for Determination of the Ovulation Status

Aims of the study: The objective of the present work was to study the effect of ovarian sex steroid hormones, estrogen and progesterone on the lateral vaginal squamous epithelia cells to determine the day of ovulation and compare it with the hormonal levels and transvaginal ultrasonography (TVUS). Methodology: The study was conducted on 40 infertile women whose ages ranged from 16 to 43 years and duration of infertility from 1 to 17 year. The reproductive history of all patients was available through filling a questionnaire form prepared for this purpose. The method depends on taking lateral vaginal smear on cycle day 11-18 (ovulatory period) and on cycle day 21-23 (midluteal phase) using Papanicolaou stain (Pap) method and compare it with the hormonal profile which were taken from all patients, serum FSH, LH and PRL on cycle day two, E2 on cycle day 11-18, P on cycle day 21-23 and TVUS at ovulatory period to determine the reliability of vaginal smears as a method for determination of ovulation especially in rural areas of Iraq where no facilities for hormonal profile and ultrasound are available. Infertile women were subdivided into three groups according to their vaginal smear results: group compatible with the hormonal profiles and TVUS (n=29), group incompatible showing an opposite picture with hormonal profiles and TVUS (n=6), group incompatible because of the inflammation of the genital system with polymorphonuclear infiltration (PMNI) masking the picture of the squamous epithelial cells (n=5). Correlation study of the vaginal smears results were performed with age of the patients, duration of infertility, hormonal levels, ovulation induction, ovulation (if present or absent) and genital infection. Results: A significant correlation was observed between vaginal smears results with LH level on cycle day 21-23, ovulation as evidenced by TVUS. The control group consisted of 10 fertile parous women with regular menstrual cycle, from which vaginal smears were taken on cycle day 21-23, where 4 of them showed ovulatory cycles, and the other 6 women showed anovulatory men-strual cycle, while the vaginal smears of 3 of the 6 women showed moderate to marked inflammation with PMNI. Conclusions: It is concluded from the results of this study that 72.5 % of the vaginal smears results were compatible with the hormonal levels and TVUS. Thus, the lateral vaginal smears may be more informative method for determination of ovulation, and examination of smears can be utilized as a tool for hormonal profile changes in the menstrual cycle in rural areas of Iraq.